Hypertension

Hypertension is commonly known to a layman as ‘BP’. Every individual has Blood Pressure which is essential to move blood through arteries and provide oxygen to the tissues of the body. Hypertension is essentially High/elevated BP viz. High Blood Pressure. High Blood Pressure is not a disease; it is a symptom indicating that an underlying disease is progressing.

Hypertension impairs the pumping function of the heart and if untreated, damages the heart, kidneys and brain in the form of Kidney disease, End stage renal disease, Kidney failure, Hardened arteries, Angina, Heart Failure, Heart attack, Stroke, Cerebrovascular disease, Cerebral haemorrhage, Eye complications, Retinal damage and Impaired vision.  It may also lead to death.

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The Normal or Optimal Blood Pressure is 120/80 mmHg. Medically, hypertension is a condition in which systolic pressure (when the heart contracts) exceeds 140mm Hg and diastolic pressure (when the heart relaxes) exceeds 90mm Hg viz. a blood pressure >140/90 mmHg is known as Hypertension.

Hypertension is of three types depending on the diastolic pressure of the heart muscle, namely, Mild Hypertension (Diastolic Pressure is 90-104 mm Hg), Moderate Hypertension (Diastolic Pressure is 105-119mmHg) and Severe Hypertension (Diastolic Pressure is 120-130mm Hg and above).

Sometimes the cause of hypertension may not be known and that condition is known as essential hypertension; the other major causes of hypertension are listed below:

• Genetic factors (Heredity, someone in the family carries the genes).
• Body weight and height- High Body Mass Index increases hypertension, it increases with both increase in weight and height.
• Age - Increase in age viz. after a certain age you may get hypertension due to several reasons.
• Gender - Rise is higher in men than in women, high in menopausal women.
• Modern lifestyle - A sedentary life devoid of exercise, stress, smoking, tobacco intake and alcohol intake.
• High viscosity of the blood due to too many red blood cells circulating in the blood stream.
• Narrowing of the main blood vessels due to hormonal secretions especially cortisone, aldosterone, adrenaline and noradrenaline.
• Increased salt intake or salt sensitivity.
• Poor dietary choices - High Calorie, High Fat diet with refined carbohydrates, High sodium, Low Potassium, Low fiber, Low Calcium, Low Magnesium.
•  Inactivity
• Other diseases.

The most common complaints among individuals with Hypertension are headache, dizziness, impaired vision, failing memory, shortness of breath, pain over the heart, gastrointestinal disturbances and unexplained tiredness.

To a large extent, hypertension can be controlled through dietary modifications. The dietary modifications aim to achieve gradual weight loss in overweight and obese individuals and maintain weight slightly below normal levels; reduce Sodium intake and maintain fluid and electrolyte balance; maintain adequate nutrition; lead a healthy lifestyle and prevent or slow down the onset of complications.

Following are the Nutrient requirements to manage hypertension effectively,

Nutrient	Note
Energy/Calorie Intake	The calories should be sufficient to maintain Ideal Body Weight. Recommended energy requirements for a sedentary activity levels is 20 Kcal/kg of Ideal Body weight and 25 kcal/kg of Ideal Body weight for moderate activity levels.
Protein	The protein intake can be normal viz. about 15-20% of the total energy requirements
Fats	Fats should compose 20% of the total energy requirements and unsaturated fats are preferred. 20g of oil per day is sufficient.
Carbohydrates	Carbohydrates should constitute 60-65% of the total energy requirements and mostly in the form of complex carbohydrates.
Calcium	Adequate calcium intake is an essential part of the treatment. It controls the strength with which blood is pumped by the heart and the amount of resistances in the flow of blood in the veins and the capillaries, both of which contribute to BP. Sources are milk and its products, greens, cereals and pulses.
Potassium	Low levels of potassium increases water and sodium retention and this can elevate BP. Fruits and vegetables are sources of potassium and fiber. Incidence of stroke increases with decrease in potassium in the blood.
Sodium Mild sodium restriction [2-3g sodium (2000-3000mg)] Moderate sodium restriction [1g sodium (1000mg)] Strict sodium restriction [0.5g sodium (500mg)]	Studies have shown that sodium restriction along with weight reduction is effective in controlling mild to moderate Hypertension along with diuretics. Depending on the severity of Hypertension, different levels of sodium intake can be recommended. Salt may be used lightly in cooking, but no salt at the table is allowed. No restrictions on naturally occurring fresh foods but avoid processed foods. Moderate restriction in both natural sources as well as processed sources. No salt in cooking is added. Limit vegetables with high sodium, avoid canned and baked products. Meat and meat products should be used in moderation. Reduces 6-1mm Hg and enhances the effects of diuretics. Apart from all the above restrictions, meat, milk and eggs are allowed in small portions and vegetables with high sodium are avoided.
Fluids	Restriction of fluids is necessary if oedema (swelling in limbs) is present. Dehydration maybe observed if they are on diuretics, hence adequate fluid intake is recommended.
Medications	Diuretics, calcium channel blockers etc.

Here is an example of Low sodium diet (less than 0.5g of sodium):

Foods allowed	Food not allowed
All cereals; pulses; fish; chicken; skimmed milk and its products; vegetables such as potato, sweet potato, tomato, gourds, cauliflower, cabbage, carrots.	Salt in cooking or at table; MSG; baking powder; sodium bicarbonate and sodium benzoate; salt preserved foods like pickles and canned foods; highly salted foods such as potato chips, ketchup, sauces, cheese, peanut butter, salted butter, shell fish, dry fish, prepared mixes, biscuits, cakes, breads, pasteries etc.

Dietary Approaches to Stop Hypertension (DASH) suggest a diet containing high amounts of fruits and vegetables, inclusion of fish, inclusion of low fat milk, reduction of fat intake and reducing sodium.

The sample serving sizes per day of different foods for DASH are:

Grains - 6 servings

Vegetables - 4-5 servings

Fruits - 4-5 servings

Milk (low fat) - 2-3 servings

Meat (lean) – 2 servings or less

Nuts and seeds - 4-5/ week

Fats and oils - 2-3 servings

Some essential Lifestyle modifications to manage Hypertension are as follows:

1. Weight Reduction - Maintain normal body weight - BMI-18.5- 22.9 kg/m²
2. Adopt Dietary Approach to Stop Hypertension - Consume diet rich in fruits, vegetables and low fat dairy products with low content of saturated and total fat.
3.  Dietary Sodium restriction -  Reduce sodium intake to no more than 6g Salt.
4. Physical activity - Engage in regular moderate aerobic activity, 30-40 mins/day.
5.  Alcohol consumption - Limit to no more than 2 drinks/day.

Post by Divya Konamme